1336278597 NPI number — DHHS PHS NAIHS SHIPROCK HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336278597 NPI number — DHHS PHS NAIHS SHIPROCK HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DHHS PHS NAIHS SHIPROCK HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DZILTH NA O DITH HLE HEALTH CENTER - PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336278597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHIPROCK
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87420-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-368-8144
Provider Business Mailing Address Fax Number:
505-368-8009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 ROAD 7586
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87413-4934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-368-8144
Provider Business Practice Location Address Fax Number:
505-368-8009
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARVEY
Authorized Official First Name:
ROBINA
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTH SYSTEM ADMINISTRATOR
Authorized Official Telephone Number:
505-368-6001

Provider Taxonomy Codes

  • Taxonomy code: 332800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B3315 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3210286 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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